Kim Joo Hyoung, Lee Il Jae, Park Myong Chul, Lim Hyoseob, Lee Seung Hun
Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Korea.
J Craniofac Surg. 2012 Jan;23(1):e52-5. doi: 10.1097/SCS.0b013e3182418d1a.
Blepharoplasty remains one of the most frequent operations in Asia. The most common complaint of Asian patients is a limitation of eye opening, and a substantial proportion of patients have puffy eyelids, supratarsal folds in the upper eyelid, and a narrow palpebral fissure, thus exhibiting a tired and sleepy appearance. To correct these features, an accurate understanding of upper eyelid anatomy is essential, especially concerning the levator aponeurosis, orbital fat, and orbital septum.
After a strip of orbicularis oculi muscle was removed through usual transcutaneous blepharoplasty incision, we excised the submuscular soft tissue to expose the fusion line of the septum and the levator aponeurosis. Blunt dissection was carried out between the levator aponeurosis and the orbital fat. During dissection, a three-dimensional fibrous web connecting the orbital fat and levator aponeurosis, and continuing to just behind the Whitnall ligament, was observed in all patients. All of the connections with these fibrous bands were resected during the procedure using a Steven scissors while controlling bleeding. After this dissection, we reevaluated the degree of blepharoptosis in the upright position and checked the function of the levator palpebral muscle. We observed that mild and subclinical blepharoptosis was corrected without manipulation of the levator aponeurosis or the Müller muscle.
Of the 32 patients evaluated, 22 were women and 10 were men. All of our patients had mild or subclinical blepharoptosis (<2 mm). The levator function was excellent or good in all patients. Most of these patients (29/32, 87.5%) were satisfied with the outcome after this operation.
The authors found that fibrous web bands between levator aponeurosis and orbital fat limit movement of the levator aponeurosis, which is a cause of eye opening limitation. In the current study, subclinical and mild blepharoptoses were corrected by releasing these fibrous bands without manipulating the levator aponeurosis or the Müller muscle. This method has been shown to be highly effective in correcting mild ptosis and can be applied during most surgical blepharoptosis techniques.
眼睑成形术仍是亚洲最常见的手术之一。亚洲患者最常见的主诉是睁眼受限，相当一部分患者有上睑臃肿、上睑皱襞及睑裂狭窄，因而呈现出疲惫、困倦的面容。为矫正这些特征，准确了解上睑解剖结构至关重要，尤其是提上睑肌腱膜、眶脂肪和眶隔。
通过常规经皮眼睑成形术切口切除一条眼轮匝肌后，我们切除肌下软组织以暴露眶隔与提上睑肌腱膜的融合线。在提上睑肌腱膜与眶脂肪之间进行钝性分离。分离过程中，在所有患者中均观察到一条连接眶脂肪与提上睑肌腱膜并延续至Whitnall韧带后方的三维纤维网。手术过程中使用史蒂文斯剪刀切除与这些纤维带的所有连接并控制出血。此次分离后，我们在直立位重新评估上睑下垂程度并检查提上睑肌功能。我们观察到，无需对提上睑肌腱膜或Müller肌进行操作即可矫正轻度和亚临床性上睑下垂。
在评估的32例患者中，女性22例，男性10例。所有患者均有轻度或亚临床性上睑下垂（<2mm）。所有患者提上睑肌功能均为优或良。这些患者中的大多数（29/32，87.5%）对此次手术后的效果满意。
作者发现提上睑肌腱膜与眶脂肪之间的纤维网带限制了提上睑肌腱膜的活动，这是睁眼受限的一个原因。在本研究中，通过松解这些纤维带矫正了亚临床性和轻度上睑下垂，而无需对提上睑肌腱膜或Müller肌进行操作。该方法已被证明在矫正轻度上睑下垂方面非常有效，并且可应用于大多数手术性上睑下垂矫正技术中。
